Provider Demographics
NPI:1578526240
Name:EGAN, CORY (DNP)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:EGAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LA RIVIERE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4344
Mailing Address - Country:US
Mailing Address - Phone:716-893-1010
Mailing Address - Fax:716-893-1002
Practice Address - Street 1:40 LA RIVIERE DR STE 201
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4344
Practice Address - Country:US
Practice Address - Phone:716-893-1010
Practice Address - Fax:716-893-1010
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041104000132OtherFIDELIS
NY9512540OtherIHA
000560586005OtherBCBS
NY00026535201OtherUNIVERA
NY000560586003OtherBC/BS
NY02345251Medicaid
00026921002OtherUNIVERA
RA0478Medicare PIN
RB4808Medicare PIN
NY00026535201OtherUNIVERA
NY02345251Medicaid